[An autopsy case of P-ANCA-positive microscopic polyangiitis with multiple cerebral hemorrhagic infarction].

A 78-year-old man who had presented with a left hemiparesis was hospitalized and diagnosed as having cerebral infarction. He developed a rapidly progressive glomerulonephritis and a massive hemorrhage of the alimentary tract, and was serologically positive for perinuclear pattern antineutrophil cytoplasmic autoantibody (p-ANCA). He passed away 19 days after the onset of the illness. The autopsy diagnosis was microscopic polyangiitis based on the histological findings of necrotizing angiitis of the small vessels, necrotizing and crescentic glomerulonephrits and alveolar hemorrhage of the lung. Neuropathological examination revealed multiple hemorrhagic infarction of the cerebral cortex caused by necrotizing angiitis. In the literature, central neurological disorders are rare in p-ANCA related vasculitis. In the case of p-ANCA related vasculitis, however, there is the possibility of cerebral infarction seen as in this case.